Not Destined for Disease, The Gifting Season

December 5, 2017 in Health by Joyce Bunderson

Yes, It’s December yet again. It reminds me that it’s been an entire year since a well-done study published in the New England Journal of Medicine (NEJM) gave many of us a gift. The gift? To me it seemed like a gift. If your family members have a history of early cardiovascular disease, you may be tempted to think that you too are destined for early cardiovascular disease and that working on a healthy lifestyle might be a waste of effort. Not so! The NEJM study found drastic reduction in risk based on positive lifestyle choices. I am one with a family having genetic risk for cardiovascular disease. This study, looking at data from four major studies that had genetic data, used a baseline of 91% greater risk of heart disease if you are in the genetic risk group, compared to those who lack the associated genes. Since I am in the high risk group, I was delighted to learn that the NEJM study found that a healthy lifestyle may decrease my 91% higher risk of heart disease, which I started life with as an innocent baby having no choice in what genes I got.

The four healthy life-style factors that the NEJM study found were so strongly linked to reducing this 91% greater risk were: avoiding obesity, following a heart-healthy dietary pattern, exercising at least once a week and no current smoking. The more favorable lifestyle habits people had, the more their risk dropped. To be specific, those who met only one of the four healthy lifestyle patterns were not significantly better than those meeting none of the four, but those meeting 3 of the 4 had a 50% reduction in risk for heart disease over the 1 and 0 groups combined.

Unlike having no choice about genes, I chose to follow all four of the healthy life-style factors for most of my life, and my check-ups for cardiovascular health are still quite positive. Now I realize that my personal case is only anecdotal, but I was so pleased when a cardiologist recently told me that I should not let anyone prescribe statins based upon my higher than normal cholesterol; because my total cholesterol is high because it is high in the good form of HDL-cholesterol. My family had familial hypercholesterolemia, but I’m assuming that my diet and exercise is helping my liver make the good cholesterol.

Holy mackerel! This NEJM study sets some easy targets – 3 our of 4 and some easy definitions. For example, they only used once a week as enough exercise. Maybe consider striving to eventually get to 150 minutes a week; that is a little more intense; but it may be a better goal. Smoking and obesity probably don’t need too much explanation. The criteria that were used in the study for a healthy diet are a little more complex. The people in the study were considered to have a healthy diet if they met six of the twelve of the following list of behaviors: (Note: Back to my anecdotal story, I noticed that I would have been in their 50% or more lowered risk group by meeting ten or eleven of the criteria most weeks.

People in the study were considered to have a healthy dietary pattern if they met at least half of these criteria:
3 or more servings of vegetables daily (non-starchy)*
3 or more servings of fruits daily*
1 or more servings of nuts per week*
2 or more servings of fish per week*
2½ or more servings of dairy products daily*
3 or more servings of whole grains daily*
Limit of 1½ servings of refined grains daily

Limit of 1 serving processed meat per week
Limit of 1½ servings unprocessed red meat weekly
Limit of 1 sugar-sweetened beverage per week
No more than 2,000 milligrams sodium daily**
Low trans fat intake**
Generally, a serving is 1 cup leafy greens or 1 piece medium fruit; ½ cup cut vegetables or fruit or 100% juice (remember that fruit juice drives up your blood sugar very rapidly – strive to get your fruit servings not as juice); ½ cup cooked grains or pasta; 1 cup cereal, milk or yogurt; 1 slice bread; 1 ounce (oz) nuts or cheese; 3.5 oz fish or unprocessed meat; 1.75 oz processed meat; 8 oz sugary beverage.
*These amounts would be appropriate if eating 2,000 calories daily; adjust amounts based on your individual calorie needs.
**Included in criteria in only one of the four study groups.

Since I’m on a roll for risk reduction based on these life-style behaviors, let me quickly share with you a study published in JAMA Oncology that came out of Harvard. They found that 30 percent of new cancer diagnoses and 50 percent of all cancer deaths in the US could be avoided. Interestingly, some of their criteria for risk reduction are the same as the NEJM study discussed above. Don’t smoke or if you do, quit; keep a healthy body weight; exercise; and cut down on alcohol. The only new factor to add to the NEJM study would be to cut down on alcohol consumption. The lead author Mingyang Song said that; “The big takeaway, is that a substantial number of cancer cases and deaths in the US can be prevented by modification of lifestyle factors. So if your family seems to have the genes to help cancer out, then read this study and try to design and switch to a lifestyle that will best support your genetic makeup. So the big two, cardiovascular disease and cancer, both respond to these life-style factors! How great it is to have things we can control; and not be under the control of our genes; and our bad, but changeable habits.

Of course, we sometimes are exposed to something in our environment or our body just doesn’t work perfectly, but reducing risk of these top two causes of morbidity and mortality in the US is worth our effort. These large and well-done studies help us realize that it’s worth our effort to pay attention to our lifestyle choices; we might not be destined for early disease. That realization is a wonderful gift for us and our families – perfect for the gifting season.